CHILD ASSENT TEMPLATE
Assent forms vary widely since they must be tailored to the particular age range and abilities of children to be involved in a particular study. Writtenassent should be obtained from any child with an intellectual age of7 years or more. This template provides an example for children ages 7-12 but can be adjusted for older children by modifying the language. If appropriate, children under 7 should be given the opportunity to understand and assent to participation in a study, whether clinical or behavioral. It is acceptable to read the assent document to these younger children. If assent is provided verbally, an assent script must still be included as part of theIRB application.
(Title of Research Project)
Researchers from the University of West Florida(namethe department) are trying to learn about(insert research objective in terms appropriate to the age of the children). You have been asked to participate because (brief explanation why the participant is being selected to participate in the research.)If you decide to participate in this study, you will be asked to(list the actions that the child will beasked to complete). You will be asked about (describe the sorts ofquestions the subject will be asked, if applicable). Some things may make you uncomfortable such as (If appropriate, include a sentence about whether or not the procedure will involve any risks& what they are).This study will take place (name the locationof the study) and should take about (estimate time involvement) of your time.
The researchers hope this study will help (explain the anticipated benefits of the research, both to the participant if appropriate, or to other children, or to society in general. If appropriate, discuss any compensation the child may receive such as a toy or gift certificate.)
You do not have to be in this study if you don’t want to and you can quit the study at any time. If you don’t like a question, you don’t have to answer it and, if you ask, your answerswill not be used in the study. No one will get mad at you if you decide you don’twant to participate.
Other than the researchers, no one will know your answers, including (namepeople that will not have access, i.e., strangers, teachers, friends, other children, etc.) If you have any questions, just ask the (name researcher).
This research study has been explained to me and I agree to be in this study.
______
Subject’s Signature for AssentDate
Check which applies to be completed by person conducting assent discussion):
The subject is capable of reading and understanding the assent form and has signed above as documentation of assent to take part in this study.
The subject is not capable of reading the assent form, however, the information was explained verbally to the subject who signed above to acknowledge the verbal explanation and his/her assent to take part in this study.
Name of Person Obtaining Assent Print)
Signature of Person Obtaining AssentDate